MEDICARE: ATI HOLDING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1417432212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATI HOLDING LLC

Provider Business Mailing Address
First Line	:	790 REMINGTON BLVD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-4909
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9512 HARFORD RD STE 3
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21234-3127
Country	:	US
Telephone Number	:	410-882-3010
Fax Number	:

Authorized Official
Title or Position	:	CCO
Name	:	LYNN MCGIVERN
Credential	:
Telephone Number	:	630-296-2222

Provider Enumeration Date	:	09/27/2018
Last Update Date	:	09/27/2018

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Practice Phone: 410-882-3010
Practice Fax:

Directions to “ATI HOLDING LLC ” Practice Location

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